Abstract
PURPOSE: Significant evidence supports a relationship between food insecurity and health, but little work has investigated its relationship on all-cause mortality within a high resource country, such as the United States. METHODS: Data from the 2003-2010 National Health and Nutrition Examination Survey was matched to National Death Index information. Cox models were used to study the relationship between mortality and food insecurity, adjusting for relevant covariates in a sequential manner (demographics, comorbidities, lifestyle variables, body mass index). Food insecurity was used as dichotomous and as four categories. RESULTS: Of 20,918 participants, 11.6% (representing 208,789,244 U.S. residents) were food insecure. When food insecurity was dichotomized, there was 49% higher odds of mortality after adjusting for demographics (HR, 1.49; 95% CI, 1.19-1.87). After adjusting for comorbidities, the HR remained significant, but lost significance with adjustment for lifestyle factors and body mass index (HR, 1.15; 95% CI, 0.94-1.42). However, marginal food security lost significance after adjustment for lifestyle variables. CONCLUSIONS: Food insecurity significantly impacts all-cause mortality in the United States; however, lifestyle may explain this relationship. Interventions should account for level of severity when creating targeted programs.